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OP ID J1 <br />` A08 -D. CERTIFICATE OF LIABILITY INSURANCE PACT -12 1 <br />DATE (MMIDDIYYYY) <br />02/19/09 <br />PRODUCER <br />ISU Insurance Services- <br />The Roger Stone Agency <br />5015 Birch Street <br />Newport Beach CA 92660 <br />Phone:949-757-0270 E'ax:949-757-0375 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED MAY _h <br />Pacific Systems Electric, Inc. <br />Charleen & Earl Jones <br />32670 Dowlin4 92596 CIT `� <br />Winchester CA 1# <br />CLE: E > . <br />ft9EA2A Scottsdale Ins. Co. <br />INSURER B' Mercury Casualty Co 11908 <br />INsuR <br />IN <br />LO <br />-41. <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />[NwSvRN <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE (MMIDDIM <br />DATE (MMIDD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE 5 l,000,000 <br />A <br />X <br />X COMMERCIAL GENERAL LIABILITY <br />CLS1547446 <br />02/02/09 <br />02/02/10 <br />PREMISES Eeoccurence $50,000 <br />CLAIMS MADE I OCCUR <br />MED EXP 'Any one person) $5,000 <br />X Owner/Coat Prot. <br />PERSONAL d ADV INJURY $1,000,000 <br />X <br />Blk' t Al, Prim/No <br />GENERAL AGGREGATE s2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />POLICY X JPEI�CT LOC <br />Emp Ban. None <br />AUTOMOBILE <br />LIABILITY <br />CSINGLE LIMIT 41 000 <br />000 <br />B <br />X <br />ANY AUTO <br />AC11063947 <br />02/01/09 <br />02/01/10 <br />(EssaceldDccident) � � <br />BODILY INJURY >: <br />ALL OWNED AUTOS' <br />X <br />SCHEDULED AUTOS <br />(Per person) <br />X <br />HIRED AUTOS <br />BODILY INJURY $ <br />X <br />NON -OWNED AUTOS <br />(Pereccldent) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ —� <br />ANY AUTO <br />AUTO ONLY. AGO $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ !t,000,000 <br />A <br />X <br />X OCCUR F_] CLAIMSMADE <br />XBS0001801 <br />02/02/09 <br />02/02/10 <br />AGGREGATE $ 4,000,000 <br />a <br />$ <br />DEDUCTIBLE <br />X RETENTION S N/A <br />$ <br />WORKERS COMPENSATION AND <br />I <br />VVUSA <br />TORY LIMITS I I r_R ' <br />EMPLOYERS' LIABILITY <br />E L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNEPJEXECUTIVE <br />E L. DISEASE - EA EMPLOYEE $ <br />OFFICERIMEMSER EXCLUDED? <br />If yes, describe under <br />E.L. DISEASE -POLICY LIMIT E <br />SPECIAL PROVISIONS below <br />OTHER <br />I <br />PPROVED A S_ To <br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS <br />RE: Electrical work for the City of Santa Ana CA. <br />Certificate Holder is naved Afdditional Insured with primary and <br />non-contributory wording per form CG20100704. Laura <br />*10 day notice of cancellation for non-payment of premium. Assistant City Attorney <br />***Revised - this certificate replaces certificate issued 2/3/09*** <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Building Maintenance Division <br />P.O.. Box 1988 <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />CITYSA9 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES, <br />0 ACORD <br />